Haphazard cholesterol checks place Australians at risk of heart disease

Nearly half of the Australians on stable lipid-lowering treatment may be having fewer than the recommended number of high-density lipoprotein (HDL-C) tests, while nearly one fifth are having more tests than is recommended, new research reveals.

The study – published today in BMJ Open (opens in a new window) – suggests many Australians may be at risk of developing cardiovascular disease because health checks are not being administered as per the national guidelines.

A team of researchers from Western Sydney University, Capital Markets CRC, University of Sydney and University of Adelaide conducted an analysis of publicly available, linked patient records within the electronic databases of the Medicare Benefit Schedule (MBS) and Pharmaceutical Benefit Scheme (PBS).

The results reveal:

49% of patients on medications to lower their cholesterol did not have the recommended annual HDL-C test in a given year.

19% of the same population received more HDL-C tests than were necessary.

Using the PBS data, the researchers collated the de-identified records of 2.4 million adult Australians who received stable prescriptions of cholesterol lowering medications over a 7-year period from 2008 to 2014 – and could therefore be determined as being at high risk of developing heart disease.

As patient records are linked to the MBS, it was then possible to determine if these same patients received the recommended, annual High-Density Lipoprotein-Cholesterol (HDL-C) test from their GP.

Dr Evan Atlantis,(opens in a new window) from the School of Nursing and Midwifery at Western Sydney University, says the results suggest that one fifth of patients are receiving too many, unnecessary tests – while half are not having their blood cholesterol levels sufficiently monitored.

“Cholesterol tests are being administered in a haphazard manner – with some patients being tested too frequently and others not enough,” says Dr Atlantis.

The BMJ Open paper explores several possible explanations for this finding. One points to a lack in continuity of care and to the fact that often people see multiple practitioners at once.

“If there is no designated ‘medical home’ for the patient, it is not clear who bears the responsibility for managing cardiovascular risk. In this scenario, it is not surprising that many individuals may miss their annual cholesterol tests,” says Dr Atlantis.

“Another contributing factor may be the lack of continuity in medical records. It is entirely possible that practitioners are not aware that some of their patients are on cholesterol medications and therefore do not take the recommended action in ordering tests.

“Another possibility is that medical practitioners are making a clinical choice not to follow the current guidelines on blood cholesterol monitoring.”

Dr Atlantis – together with co-researcher Dr Katy Bell (opens in a new window) from the University of Sydney – suggests that medical practitioners’ widespread non-adherence may be evidence that the guidelines warrant review.

“If there is high level evidence that the recommended frequency of tests leads to improved health outcomes, then the potential underutilisation of these tests in Australia warrants further attention,” says Dr Bell.

The study also identified the Federal Health Budget implications of the underutilisation of cholesterol tests.

During the study period, the yearly expenditure associated with test overutilisation was approximately A$4.3 million, while the cost averted because of test underutilisation was approximately A$11.3 million per year.

“While cost-saving, the long term health consequences of under-utilising HDL-C test are unknown and any increase in heart disease in Australia would result in a financial burden that cannot be ignored,” says Dr Atlantis.

Farshid Hajati from Western Sydney University – who developed the methodology to conduct the study and analysed the data – pointed out that there is great potential for data of this type to benefit the public.

“The next step is to quantify the consequences of not receiving the recommended level of cholesterol testing, to strengthen the current recommendations on testing frequency.”